Minimally Invasive Radio-Guided Reoperative Surgery with Intraoperative ipth Assay in Primary Hyperparathyroidism

• Authors: Marcin Barczyński , Alicja Hubalewska-Dydejczyk , Aleksander Konturek , Anna Sowa-Staszczak , Stanisław Cichoń
• Languages of publication: EN

Abstracts

EN

The aim of the study was to present the experience of the authors in employing minimally invasive radio-guided parathyroid reoperative surgery (MIRP) combined with intraoperative iPTH assay (IOPTH) in persistent and recurrent primary hyperparathyroidism (PHP) and in patients with a history of thyroidectomy.Material and methods. A prospective analysis included the results of 12 reoperations performed employing the minimally invasive method using an intraoperative hand-held gamma camera (Gamma Finder II) following IV administration of 10 mCi 99mTc-MIBI, combined with IOPTH (Future Diagnostics) in six patients with persistent PHP, one patient with recurrent PHP and five patients after subtotal strumectomies without planned parathyroidectomies (F: M = 10 : 2; mean age 54±10.7 years; mean preoperative iPTH concentration 233.3±80.6 ng/L). Prior to surgery, all the patients had been subjected to diagnostic imaging studies (parathyroid scintiscans, USG of the neck, in selected cases, SPECT and CT of the neck and mediastinum). The validity of MIRP and IOPTH in minimizing the extent of intraoperative neck exploration was assessed. Therapeutic results were evaluated in six-month postoperative follow-up.Results. All the patients were cured. The mean incision length was 3.5±0.5 cm. The mean operative time was 49±10 min. All the patients had a single parathyroid adenoma (in five cases - in the tracheoesophageal groove, in 3 - in the retroesophageal region in the neck, in one - in the retroesophageal region in the superior posterior mediastinum, in one - in the thyrothymic ligament and in two - in the thymus). The mean ratio of adenoma to background neck radioactivity was 25.7±5.4%. The mean iPTH concentration 10 min after adenoma resection was 38.5±17.4 ng/L. No postoperative complications were noted. In six-month postoperative follow-up, all the patients demonstrated normal serum calcium values.Conclusions. MIRP has proven to be highly successful in reoperations in patients with PHP. The procedure performed using a hand-held gamma camera allows for a safe execution of a minimally invasive procedure focused on resection of a single parathyroid adenoma, eliminating the need for bilateral neck exploration, which is extensive, time-consuming and associated with a higher risk of damaging the recurrent laryngeal nerve and normal parathyroids.

Keywords

EN

persistent hyperparathyroidism; recurrent hyperparathyroidism; minimally invasive radio-guided parathyroidectomy; intraoperative parathormone assay

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2008
• Volume: 80
• Issue: 9
• Pages: 469-477

Dates

published

1 - 9 - 2008

online

25 - 9 - 2008

Contributors

author

Marcin Barczyński

• Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow

author

Alicja Hubalewska-Dydejczyk

• Chair and Department of Endocrinology, Jagiellonian University College of Medicine, Cracow

author

Aleksander Konturek

• Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow

author

Anna Sowa-Staszczak

• Chair and Department of Endocrinology, Jagiellonian University College of Medicine, Cracow

author

Stanisław Cichoń

• Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow

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Identifiers

DOI

10.2478/v10035-008-0068-4